Comparison between short axis and medial oblique view for ultrasound guided internal jugular vein cannulation: Randomized controlled trial
CCCF ePoster library. Baidya D. Nov 2, 2016; 151007; 125
Assoc. Prof. Dalim Baidya
Assoc. Prof. Dalim Baidya
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Topic: Clinical Trial

Comparison Between Short Axis Out-Of-Plane Approach And Medial Oblique In-Plane Approach For Ultrasound Guided Internal Jugular Vein Cannulation: Randomized Controlled Trial

Baidya Dalim Kumar1, Maitra Souvik2, Anand Rahul1, Ray Bikash Ranjan1, Arora Mahesh Kumar1
Department of Anesthesiology Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India 
Department of Anesthesiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India


Ultrasound (US) guided internal jugular vein (IJV) cannulation is recommended technique in current anaesthesia and intensive care practice. However, classic short axis view with out-of-plane approach has inherent problem of inability to visualize puncture needle and guide-wire during venous access. In comparison, medial oblique view with in-plane approach may enhance needle visibility during puncture and decrease the area of overlap between IJV and carotid artery (1-3). 
To assess if medial-oblique view with in-plane approach increases the safety of US guided IJV cannulation over short axis view with out-of-plane approach.
Two hundred patients aged between 18-50yrs of either sex and American Society of Anesthesiologists’ physical status I-II who underwent any surgery under general anaesthesia requiring  IJV cannulation  were enrolled for this prospective randomized controlled trial. Patients were randomized by computer generated random number sequence and allocation concealment was performed by sealed envelop technique. After induction of anesthesia and controlled ventilation was initiated, patients were placed for IJV cannulation and antiseptic dressing was performed. In Medial-Oblique group (Gr M), IJV was punctured with a medial oblique probe position and in-plane approach. In this view probes were held from a medial-cephalad to a lateral-caudad direction betwen the two heads of sternocleido-mastoid at the level of cricoid cartilage. This obtained a oblique view of IJV where carotid artery was located more medially displaced than beneath the IJV usually found in short axis view. In Short-Axis group (Gr S), IJV cannulation was done in short axis probe position (probe placed transversely at the level of cricoid cartilage) and out-of-plane approach.
Needle visibility (needle tip and shaft) was significantly higher during IJV puncture in group M (68 of 98 patients in group M versus 40 of 99 patients in group S; p=0.00002). Guide wire visibility during insertion was also significantly higher in group M (59 of 98 versus 34 out of 99 in group S; p=0.00013). First insertion success rate for IJV puncture, venous access time, incidence of posterior wall of IJV puncture and time to cannulation were similar in both groups. There were no serious complications like carotid artery puncture or pneumothorax.
Medial oblique view with in-plane approach may increase safety of US guided IJV cannulation in comparison to short axis view with out-of-plane approach.
Keywords: medial-oblique view, IJV cannulation; short-axis view  


1.      Dilisio R, Mittnacht AJ. The 'medial-oblique' approach to ultrasound-guided central venous cannulation-maximize the view, minimize the risk. J CardiothoracVascAnesth. 2012;26:982-4.
2.      Baidya DK, Chandralekha, Darlong V, Pandey R, Goswami D, Maitra S. Comparative Sonoanatomy of Classic 'Short Axis' Probe Position with a Novel 'Medial-oblique' Probe Position for Ultrasound-guided Internal Jugular Vein Cannulation: A Crossover Study. J Emerg Med. 2015;48:590-6.
3.      Phelan M, Hagerty D. The oblique view: an alternative approach for ultrasound-guided central line placement. J Emerg Med. 2009;37:403-8.

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